Interest in the use of information technology and automation to address the management and dispensation of medication safely, without errors, timely and effectively has never been greater. Healthcare organizations and healthcare professionals are in agreement that medication error represents one of the most pervasive, preventable, and costly sources of patient harm.
Various devices are known, such as, a timed apparatus for dispensing medicines in U.S. Pat. No. 3,762,601 to McLaughlin, U.S. Pat. No. 4,207,992 to Brown, U.S. Pat. No. 4,572,403 and an electronic system for dispensing items (U.S. Pat. No. 3,998,356 to Christensen) and medications (U.S. Pat. No. 4,747,514 to Stone). A mechanical pill-dispensing and storage container is disclosed in U.S. Pat. No. 3,744,672 to Dangles et al., U.S. Pat. No. 4,113,098 to Howard, U.S. Pat. No. 4,512,500 to Belbin, Sr., U.S. Pat. No. 4,674,651 to Scidmore et al.
Pharmaceutical dispensing cabinets with recording systems and automatic accountability of items are disclosed in U.S. Pat. No. 4,267,942 to Wick, Jr. et al., U.S. Pat. No. 4,504,153 to Schollmeyer et al. and a computer controlled system for dispensing drugs in a health care institution is discussed in U.S. Pat. No. 4,847,764 to Halvorson.
Further innovations include a modular medication dispensing system with a microprocessor or portable memory device as disclosed in U.S. Pat. No. 4,695,954 to Rose et al. and U.S. Pat. No. 4,717,042 to McLaughlin. Improved variations of a medication dispensing system are provided by McLaughlin in Design Patent 280,132, U.S. Pat. No. 4,785,969 and U.S. Pat. No. 4,811,764 designed to dispense a variety of different medications.
Beginning in the early 1990s, the use of programmable systems (computers) for controlled access storage of medication and other pharmaceuticals in a medical facility became the state of the art as disclosed in U.S. Pat. No. 5,014,875 to McLaughlin et al., U.S. Pat. No. 5,431,299 to Brewer et al., U.S. Pat. No. 5,536,084 to Curtis et al., Reissue Patent Re. 35,743 to Pearson and U.S. Pat. No. 6,996,455 B2 to Eggenberger et al.
Most recently, specialized carts have been developed such as the computerized unit dose medication dispensing cart of Barrett in U.S. Pat. No. 6,175,779 B1 and point of care medication dispensation as shown in U.S. Patent Publication 2004/0054436 A1 to Haitin et al. and U.S. Patent Publication 2003/0120384 A1 to Haitin et al.
Thus, we find an approximately 50-year history of automated or mechanical medication dispensing systems. Systems that are centralized in medical facilities, decentralized in various treatment units and finally, point of care medication dispensing carts.
Centralized medication dispensation systems offer the advantage of a single, centralized inventory and a lower overall inventory and the disadvantages of large size, high cost, expenditure of high-cost professional time to stock and retrieve medication, and reliance on efficient delivery systems.
Decentralized, medical unit medication dispensation systems are smaller size and lower cost relative to the centrally-located devices and provide more immediate access to medications and automated documentation of medication administration with the primary disadvantage of reliance on efficient delivery systems.
Point of care systems, as described in the two U.S. Patent Publications 2003/0120384 A1 and 2004/0054435 A1 to Haitin et al., are designed to enable immediate exchange of patient data at the bedside. However, these devices are generally limited to measuring vital signs such as temperature, pulse rate and blood pressure. Collectively, the above references do not provide a point of care, respiratory therapy medication dispensing system. Further, none of the above references provide a point of care, respiratory therapy medication dispensing system capable of collecting respiratory data simultaneously with medication dispensing. Respiratory data includes measurements of, sensing or observation of such conditions as, respiratory rates, SpO2 (oxygen levels in the blood), heart rate, lung sounds, respiratory distress, work of breathing, amount and consistency of sputum production, skin color, temperature and whether or not the patient is diaphoretic (clammy, sweating).
As a further development, in 2005, the Joint Commission on Accreditation of Hospital Organizations (JCAHO) established new Patient Safety Standards that requires that all prescribed medications be dispensed to the management/dispenser systems by the hospital pharmacy. The new Patient Safety Standards by the JCAHO will reduce unwanted drug interactions and repeat dosing of similar medications by passing all prescriptions, including pulmonary prescriptions, under the watchful eye of hospital pharmacy staff. The plan is for all respiratory therapy medications to be stocked in “medication rooms” on the nursing floors into the same devices, either centralized or decentralized units, that nursing staff have been using for years.
The advantages of “medication rooms” are highlighted above in the discussion of centralized and decentralized medication dispensing units and are considered an affordable patient safety investment. The disadvantages of medication rooms include, but are not limited to, reliance on an efficient delivery system, the hectic day-to-day traffic in and out of the room by health practitioners.
In practice, shift change in the medication rooms is comparable to rush hour traffic as lines form at the dispensing system cabinet. Medication rooms are typically small and quickly become crowded with staff that are either waiting their turn at the dispensers or are preparing medications for administration to patients. In this crowded room, the risk of sharps injuries to staff is increased along with an increased risk of staff members' medications becoming mixed up with those of another staff member for lack of space.
Prior to 2005 and the implementation of the new Patient Safety Standards by the JCAHO (Joint Commission on Accreditation of Hospital Organizations), respiratory therapists maintained a private stock of inhaled medications in a medication room in the respiratory care department. Each respiratory therapist had his or her own system for organization of medication types kept in the many pockets of his or her uniform. This system which is no longer permitted under the new Patient Safety Standards, carried the risk of medication errors, but allowed for expedited delivery of patient care.
Patients are at increased risk for deterioration of their pulmonary status if a stat medication is required and the respiratory therapist has to stand in line for the patient's rescue medication. Other times patients will miss scheduled pulmonary medications because they are transferred off of the treatment floor for diagnostic tests while the therapist is in line in the medication room.
A further drawback in the medication room dispensation system for pulmonary or respiratory medications is that there is no standard method for storage and dispensation of metered dose inhalers (MDIs) that is practiced the same in all medical facilities. Frequently MDIs are stored in the medication rooms in patient-specific boxes. In some hospitals, there is some confusion as to whether nursing or respiratory therapists administer these medications which can result in double-dosing.
Still further, the medication room dispensation can result in loss of metered dose inhalers (MDIs) by respiratory and nursing staff. This results in the need for the medication to be re-dispensed by the pharmacy and the patient is re-charged for these expensive drugs. When the patient becomes aware that the charge has been made twice for an expensive medication through no fault of the patient, the hospital will be called and the charge must be removed from the bill; causing a loss of hospital revenues and personnel productivity.
If, respiratory therapy medications are the most recent addition to the dispensing systems, it is most likely that these medications will be stored in the bottom-most drawers requiring the therapist to repeatedly bend down to retrieve dispensed medications leading to an increased risk for back and knee injuries for the therapists.
Thus, it becomes apparent that there is a need for a system for the dispensation of respiratory medication designed to function within the new Patient Safety Standards; a system that moves with the therapist as they move through the hospital or medical facility administering inhaled pulmonary medication and various modalities of respiratory care. A system is needed that is designed to avoid knee and back injuries to therapists, the queuing and long waits for medications secured in centralized or decentralized units.
Thus, the need exists for solutions to the problems with the prior art.